| NPI | 1457731424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 185717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29775) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-07-25 |