| NPI | 1295883841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME54579) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME 54579) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2016-03-12 |