| NPI | 1376523621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 234513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052153) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2008-07-29 |