| NPI | 1558332718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 53331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200501860) |
| 207Q00000X Family Medicine (Licence: IN 02005420A) | |
| 207Q00000X Family Medicine (Licence: TX M7997) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-04-13 |