| NPI | 1194718288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 110468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD110468) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-11-01 |