| NPI | 1588673909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1920) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-06-16 |