| NPI | 1831238872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2009-0603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2006-0336) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-03-31 |