| NPI | 1265751267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN15063) |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2012-03-08 |