| NPI | 1114366317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 302253) |
| 207Q00000X Family Medicine (Licence: GA 075660) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2023-07-24 |