| NPI | 1306817788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 12758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 30110) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2016-12-20 |