| NPI | 1386201739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME156895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1908R77559) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-08-19 |