| NPI | 1003014838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0070342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN9181) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2024-12-27 |