| NPI | 1740270370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 34999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME107925) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2016-10-05 |