| NPI | 1417369588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN20293) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2022-07-07 |