| NPI | 1689924425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME132709) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18527) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2022-07-21 |