| NPI | 1427006436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME48853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2013-00725) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-10-31 |