| NPI | 1346383924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL os0005745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL oS5745) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2023-12-12 |