| NPI | 1497325393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT224247) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2024-08-07 |