| NPI | 1598733149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 014337) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-08-04 |