| NPI | 1245256924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL me91193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 91193) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-01-31 |