| NPI | 1205896644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 8794) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD19021) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2014-02-25 |