| NPI | 1104134295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 064850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 64850) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2011-03-09 |