| NPI | 1356357149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 5291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 34333) |
| 207Q00000X Family Medicine (Licence: NE 22583) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-02-12 |