| NPI | 1548263437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 18895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD12938) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-01-27 |