| NPI | 1083843296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 65721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 003687) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2017-03-18 |