| NPI | 1518923721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 0534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 10323) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-03-03 |