| NPI | 1457389793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 051910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-00985) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-05-08 |