| NPI | 1447236823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5358297-1205) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-03-07 |