| NPI | 1891750790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101011306) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2023-12-28 |