| NPI | 1336116532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 15666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD15666) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2023-02-15 |