| NPI | 1417336884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208974) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2018-09-04 |