| NPI | 1740332485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: NM MD2015-0147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME78008) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-02-21 |