| NPI | 1053334938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200800851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL27074) |
| 207Q00000X Family Medicine (Licence: FL ME101283) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-06-02 |