| NPI | 1093828949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 8720A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 10857) |
| 207Q00000X Family Medicine (Licence: ID M-12773) | |
| 207Q00000X Family Medicine (Licence: MO 2015003661) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2017-01-04 |