| NPI | 1225080310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-02141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 9607) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-02-19 |