| NPI | 1932580495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 273583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC151072) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2018-09-24 |