| NPI | 1700866621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME95347) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 15223 R) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2018-12-12 |