| NPI | 1538127543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 31123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 040718) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2008-10-30 |