| NPI | 1093788523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 13719) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2016-09-15 |