| NPI | 1144450891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 278817) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: ME MD19248) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2020-10-28 |