| NPI | 1245203058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007021133) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-05-21 |