| NPI | 1790751485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009062L) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2022-07-21 |