| NPI | 1134133192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 9103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2002-00489) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-03-07 |