| NPI | 1588739866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 018050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC-06-1118) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-02-13 |