| NPI | 1821512427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME159302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A157318) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-09-05 |