| NPI | 1821351651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 75014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME124267) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2020-05-29 |