| NPI | 1396862686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 017278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI 5609) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2012-04-24 |