| NPI | 1013003748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 53714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 1567) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-03-16 |