| NPI | 1003850967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49092-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49092) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-12-16 |