| NPI | 1649234808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL pa9102145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME83969) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2021-03-26 |