| NPI | 1023121316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME CNP81286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME R046787) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2022-09-07 |