| NPI | 1063647071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 39083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8608) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2012-11-19 |