| NPI | 1225491897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66174) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-01-03 |