| NPI | 1194820852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 56066) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2009-07-22 |