| NPI | 1780971754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 18829) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2023-06-21 |