| NPI | 1033537865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME164165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 305899) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2023-10-03 |