| NPI | 1356463939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL acn218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056853) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |