| NPI | 1083729560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD 2005-0645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-1924) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |