| NPI | 1174745731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME82765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME82765) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-12-19 |