| NPI | 1114095072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101250360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC-05-047) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-05-26 |