| NPI | 1265594758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301039616) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301039616) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2022-02-07 |