| NPI | 1053568923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-15715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR LL17702) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2010-09-29 |