| NPI | 1649460833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 239727) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2015-03-12 |