| NPI | 1447874920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A192148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME161339) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-01-24 |