| NPI | 1366412207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9601293) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 9601293) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-07-15 |