| NPI | 1548705239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 76960) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2021-08-02 |