| NPI | 1255563987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012024847) |
| 207Q00000X Family Medicine (Licence: IA R-8701) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2023-02-16 |