| NPI | 1073696969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 4221A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY WY4221A) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-02-23 |