| NPI | 1457301640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-36861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 21177) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2024-04-18 |