| NPI | 1841291226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME143867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 14743) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-09-20 |