| NPI | 1225476450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID o-0952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 033-T1) |
| 207Q00000X Family Medicine (Licence: WY 060-T2) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2016-07-18 |