| NPI | 1083891089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-02604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242806) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2023-09-25 |