| NPI | 1710967138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 75936) |
| 207Q00000X Family Medicine (Licence: CA GFE78880) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2020-09-15 |