| NPI | 1366425563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 42325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 33458) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2016-03-30 |