| NPI | 1972606929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0S6371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31994) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |