| NPI | 1043220775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL28842) |
| 207Q00000X Family Medicine (Licence: SC 28842) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-07-31 |