| NPI | 1376994087 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME DO2903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TP16086) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2019-08-30 |