| NPI | 1851487961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD17043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 82221) |
| 207Q00000X Family Medicine (Licence: CA G60026) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2012-11-27 |