| NPI | 1104896935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME65568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 13218) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-08-05 |