| NPI | 1073609756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 81030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-31516) |
| 207Q00000X Family Medicine (Licence: FL ME117849) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-02-15 |