| NPI | 1649455569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 017883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11431) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2022-01-24 |