| NPI | 1174608210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 4086) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301035089) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-05-12 |