| NPI | 1235190646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME85133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044879) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-05-07 |