| NPI | 1629166319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R6726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 23769) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |