| NPI | 1770609596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 51874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 12324) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-03-07 |