| NPI | 1770508087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 031102) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 031102) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-05-17 |