| NPI | 1396943080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 049559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53584-020) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2016-07-27 |