| NPI | 1013074715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME126881) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A067372) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2016-11-26 |