| NPI | 1609040849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E5683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2007018509) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2009-11-03 |