| NPI | 1750351136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D42735) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-08-19 |