| NPI | 1467806448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A151611) |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2025-03-13 |