| NPI | 1356368880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 35653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 019451) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-01-16 |