| NPI | 1255532651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 9919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 15484) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2008-12-17 |