| NPI | 1013972868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 2174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 15493) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-08 |