| NPI | 1942307640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 448) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-05-15 |