| NPI | 1154380483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS19428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV D01509) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2024-03-05 |