| NPI | 1386963908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117820) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: FL ME117820) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2015-10-28 |