| NPI | 1447632740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME135897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018502A) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2020-05-26 |