| NPI | 1699702969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR T2009-077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41570) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2009-07-01 |