| NPI | 1508919986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0057886) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 57886) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-02-07 |