| NPI | 1245522614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-02153) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-03-07 |