| NPI | 1043364227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 5854) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 5854) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-09-09 |