| NPI | 1205824786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72010-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 70283) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2024-07-03 |