| NPI | 1659326353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 033089E) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2014-02-05 |