| NPI | 1245263094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 200837) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2017-12-01 |