| NPI | 1053756254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 76714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0070695) |
| 207Q00000X Family Medicine (Licence: AZ 66761) | |
| 207Q00000X Family Medicine (Licence: NC 2023-03051) | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2024-05-09 |