| NPI | 1801829643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 23055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 11496) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-06-14 |