| NPI | 1124150396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7717A) |
| 207Q00000X Family Medicine (Licence: VA 0101243332) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2024-09-05 |