| NPI | 1285798405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 36577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11353) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2012-08-28 |