| NPI | 1487744934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 032846) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-05-01 |