| NPI | 1760651285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090215) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2011-11-15 |