| NPI | 1821182288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240462) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101240462) |
| 207Q00000X Family Medicine (Licence: FL ME165132) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-04-07 |