| NPI | 1467490623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0060121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0060121) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2024-02-22 |