| NPI | 1306821848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201402238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 055274) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2022-10-24 |