| NPI | 1467864660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN20219) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2022-01-05 |