| NPI | 1457552705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5458) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-04-08 |