| NPI | 1194111732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME156169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 56453) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2024-08-23 |