| NPI | 1043275522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 6413) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-10-20 |