| NPI | 1730246745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 26649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 23452) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-09-15 |