| NPI | 1316170830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02373) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 2237) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2014-04-07 |