| NPI | 1184740110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107493) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 29069) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-06-20 |