| NPI | 1033406053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD188825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME128050) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2018-10-23 |