| NPI | 1649590605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118383) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2009-0779) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2021-06-08 |