| NPI | 1841553864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL34659) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2024-05-07 |