| NPI | 1124275896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102752) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL TRN10317) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2020-03-10 |