| NPI | 1407917867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201502425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40270) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2024-04-24 |