| NPI | 1063653285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2012-0540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0139369) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2023-06-08 |