| NPI | 1306801634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.024152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 024152) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-09-17 |