| NPI | 1063429769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 026154) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 026154) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2013-07-31 |