| NPI | 1023071529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 29743) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2019-08-20 |