| NPI | 1215957402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 5931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 3623) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |