| NPI | 1831488402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 116518) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 048699) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2024-02-02 |