| NPI | 1083654206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 119352) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-07-21 |