| NPI | 1740248897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 23447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 23443) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-11-10 |