| NPI | 1649212887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 28-000216) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 023486) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-10-24 |