| NPI | 1881981918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69830) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 9199) |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2024-10-21 |