| NPI | 1417913591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 98020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0064882) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-05-12 |