| NPI | 1124686043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME DO3361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019200) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2022-07-14 |