| NPI | 1417157397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-2055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 40961) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2024-06-20 |