| NPI | 1235796277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN28149) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-04-08 |