| NPI | 1447429451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME126391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-33807) |
| 207Q00000X Family Medicine (Licence: MI 4301088531) | |
| Enumeration Date | 2008-02-23 |
| Last Update Date | 2024-10-09 |