| NPI | 1295911030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 42041) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 81723) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2014-01-29 |