| NPI | 1598997629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC091011) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2012-12-19 |