| NPI | 1225131329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00006951) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2013-10-07 |