| NPI | 1174985808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83498-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10395937-1205) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-06-14 |