| NPI | 1689672784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 7841) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 22475) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-11-02 |