| NPI | 1841371697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 44268) |
| 207Q00000X Family Medicine (Licence: NC 200700809) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-04-22 |