| NPI | 1154367811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51478-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044708) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2010-12-22 |