| NPI | 1528132032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 87664) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301031927) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2022-01-14 |