| NPI | 1639297674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-128574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 173T2) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-09-07 |