| NPI | 1386866325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 7596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7803) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-03-23 |