| NPI | 1205808029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME86862) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2011-11-30 |