| NPI | 1740297696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 9609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 209857) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-09-07 |