| NPI | 1477640480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-02293) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35048) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NC 2017-02293) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2024-04-26 |