| NPI | 1902146822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME79221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME79221) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME79221) | |
| 208D00000X General Practice (Licence: FL ME79221) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2023-02-22 |