| NPI | 1710203435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME103629) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: FL ME103629) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2022-06-01 |