| NPI | 1700847969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME133342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 009801451) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-05-03 |