| NPI | 1184787327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 064178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 36513) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2015-07-30 |