| NPI | 1295044568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 12 790 - I) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2019-04-19 |