| NPI | 1205894847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-027020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0055562) |
| 207Q00000X Family Medicine (Licence: GA 92684) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-12-21 |