| NPI | 1770570236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 065085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18711) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2015-02-05 |