| NPI | 1326496605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME-158810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-44590) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2023-08-15 |