| NPI | 1962763979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C182803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.38157) |
| 207Q00000X Family Medicine (Licence: VA 0101254821) | |
| 207Q00000X Family Medicine (Licence: FL ME137725) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2024-06-21 |