| NPI | 1083687610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7741) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA OS004679L) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-11-05 |