| NPI | 1811901390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24166) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-03-07 |