| NPI | 1104854660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023044254) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 81270) |
| 207Q00000X Family Medicine (Licence: CA 72315) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-10-21 |