| NPI | 1023110780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301065434) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2024-01-03 |