| NPI | 1023204641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD21022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL10577) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2022-02-03 |