| NPI | 1255602918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 1651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-12461) |
| 207Q00000X Family Medicine (Licence: WY 003-T1) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2024-04-11 |