| NPI | 1265415566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS-1532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO773) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-11-27 |