| NPI | 1073511978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1716) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2009-07-02 |