| NPI | 1033446349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 105585) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME105585) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2011-06-28 |