| NPI | 1235247313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD18115) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2018-07-19 |