| NPI | 1376708321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D75893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 66074) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2024-04-02 |