| NPI | 1346430956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 202067) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2022-02-10 |