| NPI | 1578552766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 018043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 49653) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2011-02-09 |