| NPI | 1790731107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 11209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD17946) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-02-25 |