| NPI | 1477763423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L2624) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-09-06 |