| NPI | 1831280197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009027850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP5454) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-08-27 |