| NPI | 1780610071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID M-9168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M9168) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2023-06-07 |