| NPI | 1467434134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-00474) |
| Additional Taxonomies | 208VP0000X (Licence: NC 2011-00474) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-04-21 |