| NPI | 1013002526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0032429) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-08-04 |