| NPI | 1982635173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18255) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-06-16 |