| NPI | 1497934004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME144882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0069351) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2020-07-09 |