| NPI | 1811951593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 062364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 20613) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2010-01-27 |