| NPI | 1588629760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 3345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 18266) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-11-19 |