| NPI | 1154646842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0055831) |
| Additional Taxonomies | 202K00000X (Licence: FL ME143057) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2025-02-15 |