| NPI | 1013920875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 15172r) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 15172R) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-12-17 |