| NPI | 1619993649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 26918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME90551) |
| 207Q00000X Family Medicine (Licence: AL 00026918) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-03-03 |