| NPI | 1215385067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME138213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD468572) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2022-07-13 |