| NPI | 1821655929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME156999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 15221-I) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-11-07 |