| NPI | 1386664654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0869) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-09-23 |