| NPI | 1013204742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 337414) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-2399) |
| 207Q00000X Family Medicine (Licence: MS 23130) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-11-07 |