| NPI | 1215115639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 14519) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 51170) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2010-08-16 |