| NPI | 1043271158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-00828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R8A35) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2024-07-11 |