| NPI | 1811202567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD155970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME107672) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2011-10-14 |