| NPI | 1578756904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 30039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL30039) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2023-05-11 |