| NPI | 1144283219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME28296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OOME28296) |
| 208D00000X General Practice (Licence: FL ME28296) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2022-09-19 |