| NPI | 1316035827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 1660960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 01012455612) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-04-13 |