| NPI | 1235146440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52590) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-03-23 |