| NPI | 1023076619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR R3698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013042315) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-10-16 |