| NPI | 1356482426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2020-0934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 36573) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2023-08-31 |