| NPI | 1346206257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME94941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0202) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2020-01-08 |