| NPI | 1528068483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 41543) |
| 207Q00000X Family Medicine (Licence: AZ 35174) | |
| 207Q00000X Family Medicine (Licence: WA MD60158774) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2023-11-27 |