| NPI | 1528355500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 12504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL11922) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2023-12-27 |