| NPI | 1811034986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME138637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-5084) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-09-12 |