| NPI | 1194862417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-17694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD155014) |
| 207Q00000X Family Medicine (Licence: WI 47273) | |
| 207Q00000X Family Medicine (Licence: ID M-9938) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-04-04 |