| NPI | 1578646345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-9739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY A4684) |
| 207Q00000X Family Medicine (Licence: MT 5069) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-08-06 |