| NPI | 1093002768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 64989) |
| 207Q00000X Family Medicine (Licence: MS 816-L) | |
| 207Q00000X Family Medicine (Licence: ME MD23047) | |
| 207Q00000X Family Medicine (Licence: TN MD0000058679) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2019-05-20 |