| NPI | 1386820553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 83783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P7580) |
| 207Q00000X Family Medicine (Licence: FL ME 113093) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2023-03-13 |