| NPI | 1154585990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2012-0121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM rs2008-0187) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2017-03-07 |