| NPI | 1477101764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11422103-1205) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2019-12-19 |