| NPI | 1689645566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1888) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2019-01-02 |