| NPI | 1700837853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 63126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 34116) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2023-06-19 |