| NPI | 1295046621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 48027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9652815-1205) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2018-03-19 |