| NPI | 1487810503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME130329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116018137) |
| 207Q00000X Family Medicine (Licence: VA 0101245823) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2017-03-21 |