| NPI | 1699770990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME80458) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME80458) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-12-02 |