| NPI | 1285831156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R1077) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2013-09-24 |