| NPI | 1407817778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D065990) |
| Additional Taxonomies | 174400000X Specialist (Licence: GU 174400000x) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2013-09-08 |