| NPI | 1841411444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 7034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD RL-0443) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-04-14 |