| NPI | 1174565188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 034767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 8749) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-07-14 |