| NPI | 1235104886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014010401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 037522) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2024-06-18 |