| NPI | 1609850775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD201470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME90790) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2022-09-30 |