| NPI | 1497754592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 046925) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00026131) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2014-02-24 |