| NPI | 1093080384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.206418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 23650) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2016-08-11 |