| NPI | 1811972706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205195) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2023-12-08 |