| NPI | 1144246729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-165550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP818) |
| 207Q00000X Family Medicine (Licence: SC LL29132) | |
| 207Q00000X Family Medicine (Licence: FL ME104586) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-05-09 |