| NPI | 1124407564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A162416) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2020-07-08 |