| NPI | 1891894929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35078457Z) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-05-23 |