| NPI | 1912088766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME106179) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 7812) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 106179) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-05-20 |