| NPI | 1154419182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2024012818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD26719) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-07-30 |