| NPI | 1083901177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301111119) |
| Enumeration Date | 2011-07-09 |
| Last Update Date | 2024-05-16 |