| NPI | 1861432296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 14439) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-02-04 |