| NPI | 1093811481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD18331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TD081128) |
| 207Q00000X Family Medicine (Licence: ME 018331) | |
| 207Q00000X Family Medicine (Licence: CT 019339) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2022-07-21 |