| NPI | 1346274214 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 126911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9401278) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-09-21 |