| NPI | 1801022892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME124076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 43576) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2024-03-07 |