| NPI | 1942662192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137726) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME137726) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2020-12-11 |