| NPI | 1023400249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 073226) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2016-06-15 |