| NPI | 1558473769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 25896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 9785) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2013-08-29 |