| NPI | 1992719686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME29312) |
| Additional Taxonomies | 171W00000X Contractor (Licence: FL ME0029312) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2010-07-27 |