| NPI | 1689883860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35096156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0017894-comp) |
| 207Q00000X Family Medicine (Licence: TX V1990) | |
| 207Q00000X Family Medicine (Licence: GA tm209) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-09-24 |