| NPI | 1790817518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 12282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 038424) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-09-27 |