| NPI | 1316254493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 18445) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2023-11-27 |