| NPI | 1922394030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME120789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 16686) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2014-12-30 |