| NPI | 1053372920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 21591-875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 23094) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2022-06-09 |