| NPI | 1184630899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD156827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 93-271) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-07-31 |