| NPI | 1144229857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 13801) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 030496) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2007-07-09 |