| NPI | 1356566459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 28279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 30767) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-06-02 |