| NPI | 1164424701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 21191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 34701) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2022-08-16 |