| NPI | 1144202052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME90823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 26141) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2022-01-12 |