| NPI | 1093791113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 17973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL me 94347) |
| 207Q00000X Family Medicine (Licence: GA 056858) | |
| 207Q00000X Family Medicine (Licence: WA md00045859) | |
| 207Q00000X Family Medicine (Licence: ME MD24218) | |
| 207Q00000X Family Medicine (Licence: MS 17939) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2024-09-05 |