| NPI | 1083654248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02933) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-06-12 |