| NPI | 1205070711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 122877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 54825) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2021-01-12 |