| NPI | 1417164658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 105554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 13868) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2016-05-11 |