| NPI | 1588621114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2132) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28048) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2011-07-20 |