| NPI | 1992986897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 62422-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0011885) |
| 207Q00000X Family Medicine (Licence: CA A96990) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2024-08-07 |