| NPI | 1861680738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 28957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME101886) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2008-09-19 |