| NPI | 1215922059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101009333) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI DW009333) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-11-02 |