| NPI | 1992828461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD27988) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-03-14 |