| NPI | 1356307441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 81570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 34255) |
| 207Q00000X Family Medicine (Licence: LA 10855768) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2024-04-11 |