| NPI | 1144541335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 26891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39715) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2014-01-28 |