| NPI | 1669449229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200600428) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2018-12-13 |