| NPI | 1629089974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R7881) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-08-09 |