| NPI | 1174961429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME126544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN19165) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2016-07-08 |