| NPI | 1013093475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6206733-1205) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2023-12-27 |