| NPI | 1073950200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN18888) |
| 207Q00000X Family Medicine (Licence: ME MD20949) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2020-01-22 |