| NPI | 1013079813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 97513) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 97-513) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-07-27 |