| NPI | 1467629964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 71204) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2014-09-29 |