| NPI | 1841201274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 21707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME76790) |
| 207Q00000X Family Medicine (Licence: IL 036095495) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2008-06-19 |