| NPI | 1548600430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 075777) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2025-02-03 |