| NPI | 1275731622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 51999) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2016-10-08 |