| NPI | 1275559080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0865) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-09-26 |