| NPI | 1720379365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117518) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME117518) |
| Enumeration Date | 2011-05-01 |
| Last Update Date | 2020-01-08 |