| NPI | 1336357136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME99248) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 8241) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-07-20 |