| NPI | 1023241403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.205467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 14355) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2021-06-08 |