| NPI | 1407817364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-7049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M7049) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2015-02-27 |