| NPI | 1962478073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60240474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 013896) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2023-09-07 |