| NPI | 1417963026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 056212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200101250) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-05-13 |