| NPI | 1982808762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 93192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA md.200841) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2025-01-01 |