| NPI | 1750519278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC TL1638) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-10-11 |