| NPI | 1417914516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC TL30486) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2004-00433) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2008-01-31 |