| NPI | 1346226453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC MD23135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 23135) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2018-02-22 |