| NPI | 1124024047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 109076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0059846) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-03-24 |