| NPI | 1285677294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME120275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40243) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-01-23 |