| NPI | 1053382093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 82258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-01499) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2024-06-07 |