| NPI | 1699916999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 51869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60032175) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2013-08-05 |