| NPI | 1841290129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101053663) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-11-22 |