| NPI | 1235120437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 0000058871) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-00933) |
| 207Q00000X Family Medicine (Licence: WY 6042A) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2023-12-14 |