| NPI | 1922250729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME112789) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 42045) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2012-06-04 |