| NPI | 1336138809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9801320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 070497) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2025-01-13 |