| NPI | 1568460921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2007-00384) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 028399) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2023-12-07 |