| NPI | 1235152950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD 7426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 0041013) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-04-07 |