| NPI | 1407887318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 066956) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-03-15 |