| NPI | 1972641652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41138) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-10-07 |