| NPI | 1750551941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME128225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI AS306250860) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2023-01-18 |