| NPI | 1245591098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 263909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME DO2506) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2017-02-03 |