| NPI | 1760453013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 23855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 111963) |
| 207Q00000X Family Medicine (Licence: CA 80032) | |
| 207Q00000X Family Medicine (Licence: FL ME111963) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-11-10 |