| NPI | 1104853183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME141085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 10281) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-11-06 |