| NPI | 1275613218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME27137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-01967) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2023-03-07 |