| NPI | 1922291905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 002809) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2012-03-27 |