| NPI | 1740213537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 041113) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2021-08-16 |