| NPI | 1932117298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 24828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 057969) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2013-09-27 |