| NPI | 1043218340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 206252) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0071012) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2013-07-24 |