| NPI | 1154636280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: ME MD21299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD21299) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2017-04-28 |