| NPI | 1215905518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 7037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48374) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2009-09-04 |