| NPI | 1295718245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME31278) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME31278) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2012-11-28 |