| NPI | 1285756007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME102376) |
| 207Q00000X Family Medicine (Licence: WY 8439A) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2014-10-22 |