| NPI | 1295048296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN15613) |
| 363A00000X Physician Assistant (Licence: VA 0110003356) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2023-02-02 |