| NPI | 1558772426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT206822) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2023-09-10 |