| NPI | 1245351659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 039961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 30773) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2009-01-26 |