| NPI | 1538201629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200901294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC RTL) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2023-10-23 |