| NPI | 1326032566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 18996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200100263) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-06-28 |