| NPI | 1619193943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L-2646) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2009-05-27 |