| NPI | 1063433050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 22420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 043063) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2010-10-17 |