| NPI | 1225024144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 44937) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME0044937) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-02-05 |