| NPI | 1336186782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0013956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 014336) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2018-02-05 |