| NPI | 1669590477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL27933) |
| 207Q00000X Family Medicine (Licence: SC 27933) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2024-07-08 |