| NPI | 1811152416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN13138) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2011-08-05 |