| NPI | 1497743116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD203790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 27015) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2024-12-13 |