| NPI | 1215922182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME163322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 42087) |
| 207Q00000X Family Medicine (Licence: WA MD60491863) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2024-06-12 |