| NPI | 1609989359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M5074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME156986) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-02-22 |