| NPI | 1750319521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 98531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 200364) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-01-26 |