| NPI | 1427460526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN19942) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2020-12-17 |