| NPI | 1366738494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 40594) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA 40594) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-08-15 |