| NPI | 1073712725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD19943) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-07-29 |