| NPI | 1174586861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-6158) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2015-12-21 |