| NPI | 1629555966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME149997) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15074) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2021-07-01 |