| NPI | 1609135011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015027593) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-10-19 |