| NPI | 1730275876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M6671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD216301) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2024-04-02 |