| NPI | 1376560938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01665) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9143) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-05-19 |