| NPI | 1245200161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 22632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101-234556) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2022-11-23 |