| NPI | 1538156153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 6407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 18983) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2011-08-15 |