| NPI | 1871542043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0089778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME89778) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-06-06 |