| NPI | 1073691150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 30365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 85273) |
| 207Q00000X Family Medicine (Licence: CT 26397) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |