| NPI | 1487183968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-12549) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME142852) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-11-05 |