| NPI | 1093078479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 13446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL12375) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2015-08-11 |