| NPI | 1114945433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 24811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 012569) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-02-15 |