| NPI | 1912998147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 22747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME77956) |
| 207Q00000X Family Medicine (Licence: GA 044374) | |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2011-06-20 |