| NPI | 1184031841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME99578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01795) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2024-08-05 |