| NPI | 1063640266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD159697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003992) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2012-09-12 |