| NPI | 1083926414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8933) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2013-02-20 |