| NPI | 1477576478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 17521) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-08-01 |