| NPI | 1861449126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 238662) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 37467) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2009-03-27 |