| NPI | 1801096821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01366) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL1085) |
| 208D00000X General Practice (Licence: NC 2012-01366) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2023-10-14 |