| NPI | 1114936606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 35653) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 35653) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2024-07-15 |