| NPI | 1891920328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME112803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 258623) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2016-07-26 |