| NPI | 1154411486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 31560-20) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 31560) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-11-21 |