| NPI | 1740542232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME T1278) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2024-12-23 |