| NPI | 1003899618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 40887020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 15437) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2021-09-29 |