| NPI | 1073171435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 23857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC191058) |
| 207Q00000X Family Medicine (Licence: ME MD24133) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-07-24 |