| NPI | 1790730661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME58350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0058350) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2010-01-14 |