| NPI | 1538470646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME157188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32940) |
| 207Q00000X Family Medicine (Licence: GA 70459) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2022-07-22 |