| NPI | 1093195331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6501740-1205) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2022-10-14 |