| NPI | 1447293386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0097763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 308182) |
| 207Q00000X Family Medicine (Licence: FL ME65202) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-01-10 |