| NPI | 1366416232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107676) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD425999) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-04-16 |