| NPI | 1629017041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 048110) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2013-09-16 |