| NPI | 1962637827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-03221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1620) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2024-01-29 |