| NPI | 1366410268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME98478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101234721) |
| 207Q00000X Family Medicine (Licence: PR 12427) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2013-05-17 |