| NPI | 1063473320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MMD33307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 29550) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2013-09-23 |