| NPI | 1346348059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115803) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA3755) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-02-28 |