| NPI | 1376523712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200401235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18610) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-09-10 |