| NPI | 1477519361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME85025) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2005-0209) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2019-10-27 |