| NPI | 1083619498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 27828) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 27828) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2009-11-16 |