| NPI | 1336398510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 20747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001802) |
| Enumeration Date | 2008-09-12 |
| Last Update Date | 2013-07-18 |