| NPI | 1285073890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 338347) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 23591) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-10-23 |