| NPI | 1114035243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 065543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0047275) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2012-11-26 |