| NPI | 1255355087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 50368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD170487) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-09-25 |