| NPI | 1720269608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006014651) |
| 207Q00000X Family Medicine (Licence: CT 048058) | |
| 207Q00000X Family Medicine (Licence: MO 2010029567) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2014-02-10 |