| NPI | 1609830918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200301358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E5319) |
| 207Q00000X Family Medicine (Licence: KY 56274) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2022-04-14 |