| NPI | 1528219813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 066097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 246442) |
| 207Q00000X Family Medicine (Licence: FL ME103333) | |
| Enumeration Date | 2008-10-05 |
| Last Update Date | 2024-08-18 |