| NPI | 1144270026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 21910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 8551) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-10-06 |