| NPI | 1336376086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 44333) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2024-09-05 |