| NPI | 1043211022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0066068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TD071067) |
| 207Q00000X Family Medicine (Licence: ME 017950) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-10-26 |