| NPI | 1134428626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45335) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-07-18 |