| NPI | 1114106747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL#29972) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2023-02-10 |