| NPI | 1609881440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 025712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18607) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2022-04-28 |