| NPI | 1013091255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 5022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1312) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2011-11-03 |