| NPI | 1184766628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301085437) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2021-11-29 |