| NPI | 1760442834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME144087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD93488) |
| 207Q00000X Family Medicine (Licence: IN 01054071A) | |
| 207Q00000X Family Medicine (Licence: GA 065445) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2025-08-24 |