| NPI | 1841222403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 22926) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-09-13 |