| NPI | 1992966352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 31021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097004) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2024-03-20 |