| NPI | 1639152515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 049486) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 49486) |
| 207Q00000X Family Medicine (Licence: AL 24100) | |
| 207Q00000X Family Medicine (Licence: CO 43902) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2008-05-22 |