| NPI | 1154618130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11964) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2023-06-14 |