| NPI | 1265418644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 16908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1314) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2007-12-04 |