| NPI | 1306814470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-2379) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-27 |