| NPI | 1851774632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0014115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC151073) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2018-08-07 |