| NPI | 1366068876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 30997) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2023-07-18 |