| NPI | 1831342823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0009962) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2016-02-11 |