| NPI | 1568750941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E8737) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2021-04-14 |