| NPI | 1871113613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD26953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME166708) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-10-27 |