| NPI | 1194757567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 7437) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-11-01 |