| NPI | 1710992581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 100685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 67035) |
| 207Q00000X Family Medicine (Licence: FL ME95825) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2024-01-25 |