| NPI | 1487680419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18096) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010086L) |
| 207Q00000X Family Medicine (Licence: NV 1295) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2022-10-26 |