| NPI | 1851486468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME72263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0072263) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-03-07 |