| NPI | 1740440098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1634-11) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A16341) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2024-08-08 |