| NPI | 1477818227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 13991) |
| 207Q00000X Family Medicine (Licence: NM MD2017-0639) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2024-02-16 |