| NPI | 1801074836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0S012598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH NH9168) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |