| NPI | 1609189901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 70039) |
| 207Q00000X Family Medicine (Licence: NH 24746) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2023-11-21 |