| NPI | 1285949560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 25906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11228) |
| 207Q00000X Family Medicine (Licence: AZ 2324) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2014-09-12 |