| NPI | 1508306069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 306085) |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2022-08-12 |