| NPI | 1235122714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-13395) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11095) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2016-09-23 |