| NPI | 1225299357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0989) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2014-08-04 |