| NPI | 1700205424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD465714) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-11-16 |