| NPI | 1093783672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 45182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 09184) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2023-11-21 |