| NPI | 1023053972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 2822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 02822) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2021-07-09 |