| NPI | 1407878762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0077894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME00777894) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0077894) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2011-02-09 |