| NPI | 1285604512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R9D23) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD R9D23) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-11-01 |