| NPI | 1083620090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 49059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 23409) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-06-27 |