| NPI | 1407837438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052930) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-01-11 |