| NPI | 1780829168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60864272) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME LT22008) |
| 207Q00000X Family Medicine (Licence: VA 0102206048) | |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2022-08-12 |