| NPI | 1043522915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME120589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.058880) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2015-07-21 |