| NPI | 1558587717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL9703) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-01-04 |