| NPI | 1376517201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 22358) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-10-10 |