| NPI | 1174919872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 277330) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2023-08-01 |