| NPI | 1700935525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 60127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 048742) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-10-03 |