| NPI | 1952410904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 23905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 3557561205) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-09-27 |