| NPI | 1376795674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 58207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 018557) |
| 207Q00000X Family Medicine (Licence: MI 4301090669) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2023-11-27 |