| NPI | 1760446074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117702) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: FL ME117702) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-04-22 |