| NPI | 1326305004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12951) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73187) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2016-12-05 |