| NPI | 1306918784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 25321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 028279) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |