| NPI | 1124102389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 1112) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 10162) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-10-25 |