| NPI | 1861594335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A89394) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2023-01-18 |