| NPI | 1790851483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME DO1740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1740) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2023-12-19 |