| NPI | 1457318503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 070678) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101058012) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-11-13 |