| NPI | 1861475717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME92077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 217492) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2010-11-08 |