| NPI | 1093718868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME32564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 019630) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2013-03-11 |