| NPI | 1609822055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 0904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 30526) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2011-11-25 |