| NPI | 1619062155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 102253) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME94779) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-02-04 |