| NPI | 1538375613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 9651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 31426) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-03-07 |