| NPI | 1063851277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.32611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME116951) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2013-08-18 |