| NPI | 1215513262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 100149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME163815) |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2024-07-02 |