| NPI | 1962542365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-02471) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 23944) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-01-19 |