| NPI | 1669487542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 044942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203390) |
| 207Q00000X Family Medicine (Licence: FL OS18875) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL os18875) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2024-04-30 |