| NPI | 1881125714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME164661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 54197) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-09-22 |