| NPI | 1164837605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VT 032.0133827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV ED0456A) |
| 207U00000X Nuclear Medicine (Licence: IL 125.066294) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-06-30 |