| NPI | 1598835787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 26496) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2021-03-25 |