| NPI | 1982831657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012008171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 36591) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2024-11-11 |