| NPI | 1407002793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2008-0648) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2010-12-02 |