| NPI | 1104180835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.124541) |
| 207Q00000X Family Medicine (Licence: GA 76689) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2024-10-17 |