| NPI | 1205944220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME162463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 31919) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-01-24 |