| NPI | 1356333603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME86570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0067446) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2023-11-02 |