| NPI | 1295738250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C20005296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS19663) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-08-18 |