| NPI | 1003250481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-01284) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2023-07-09 |