| NPI | 1356549851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200800214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC TL30299) |
| 207Q00000X Family Medicine (Licence: SC 30299) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2023-04-20 |