| NPI | 1710243670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 122688) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME122688) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2016-02-08 |