| NPI | 1720073547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME157057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101047986) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-09-25 |