| NPI | 1073952537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013018129) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2024-07-19 |