| NPI | 1205802642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2020-0263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 21711) |
| Enumeration Date | 2006-02-26 |
| Last Update Date | 2024-09-06 |