| NPI | 1942649751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 72259-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1275) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2024-09-20 |