| NPI | 1649245044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD25344) |
| 207Q00000X Family Medicine (Licence: NC 200200592) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2022-01-21 |