| NPI | 1104895382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 000490) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CT 000490) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-05-30 |