| NPI | 1558384776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 12902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 30671) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-01-17 |