| NPI | 1407118508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34724) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL34724) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2015-06-22 |