| NPI | 1043282858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 073325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 110203) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2016-11-03 |