| NPI | 1033102710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 12990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2010-0550) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2024-09-10 |