| NPI | 1538193065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 199917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22112) |
| 207Q00000X Family Medicine (Licence: AR E-3991) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-04-05 |