| NPI | 1740279033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME63053) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2012-05-08 |