| NPI | 1275636623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 34951) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 34951) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2015-08-11 |