| NPI | 1801897426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 2720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 17148) |
| 207Q00000X Family Medicine (Licence: WY 3723A) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2023-10-20 |