| NPI | 1174517825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2004020481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2011-0716) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2015-12-15 |