| NPI | 1699967877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 201567) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2023-01-12 |