| NPI | 1932693421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME168959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15160) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-11-04 |