| NPI | 1215919345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 61987) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: GA 61987) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2011-03-10 |