| NPI | 1467568766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R7878) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2009-07-16 |