| NPI | 1447463682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-00192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL28839) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-06-27 |