| NPI | 1073993135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 21810) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2018-07-13 |