| NPI | 1013203280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-46149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 114336) |
| Enumeration Date | 2011-06-25 |
| Last Update Date | 2021-02-25 |