| NPI | 1346241197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 26532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 4085) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-09-10 |