| NPI | 1821065657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 23321) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2021-01-28 |