| NPI | 1013000173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 40216) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-10-30 |