| NPI | 1821059312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS-0007275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0007275) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2008-12-24 |