| NPI | 1013246990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35096334) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2021-06-07 |