| NPI | 1659460764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME45888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 45888) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-05-06 |