| NPI | 1225109382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 42433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42433-020) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2024-03-14 |