| NPI | 1215023791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO173012) |
| 207Q00000X Family Medicine (Licence: TX K2674) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-06-09 |