| NPI | 1912906819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 91-272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2000167451) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2022-05-20 |