| NPI | 1427139294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 23704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006034640) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-02-22 |