| NPI | 1902880198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME141960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101-052994) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-10-01 |