| NPI | 1770527384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OR DO21474) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A8048) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-07-08 |