| NPI | 1568664514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 0033400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME134596) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-07-15 |