| NPI | 1770560450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD C0005080) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005080) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2024-05-08 |