| NPI | 1861691032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147137) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01063988A) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-09-23 |