| NPI | 1801855911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 34500) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2023-08-21 |