| NPI | 1811157969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105310) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN12963) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2013-09-03 |