| NPI | 1700438454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT218891) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2023-01-12 |