| NPI | 1083655211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-00739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 20449) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-04-05 |