| NPI | 1073710364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102442) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL TRN10902) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-06-02 |