| NPI | 1013112119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL29777) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-03-15 |