| NPI | 1649262106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2006001772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 51139) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2012-01-26 |