| NPI | 1982601159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 110249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 12292) |
| Enumeration Date | 2005-07-03 |
| Last Update Date | 2020-07-22 |