| NPI | 1811066996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME42669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200900283) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-12-19 |