| NPI | 1528371812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME127506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010023080) |
| 207Q00000X Family Medicine (Licence: MO 2011027697) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2022-07-21 |