| NPI | 1124008156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME76603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2015-01511) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-07-29 |