| NPI | 1598707226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 0-244) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO171781) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2025-01-06 |