| NPI | 1699771014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME168847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9501407) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-09-25 |