| NPI | 1710193354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301083718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME132454) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-11-23 |