| NPI | 1952303273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-02262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 19095) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-11-18 |