| NPI | 1053352609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 1097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME LT23002) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-04-27 |