| NPI | 1447558614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101257804) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2021-11-11 |