| NPI | 1801967922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 017713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC-05-017) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2011-04-08 |