| NPI | 1003844796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-00335) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2016-07-20 |