| NPI | 1891984647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 14575) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 2299-850) |
| 207Q00000X Family Medicine (Licence: WI 50976-20) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2010-08-16 |