| NPI | 1245206648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41285) |
| 207Q00000X Family Medicine (Licence: MN 42041) | |
| 207Q00000X Family Medicine (Licence: IA 04555) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-04-16 |