| NPI | 1245251081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 19059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9800465) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-11-24 |