| NPI | 1417059130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3470) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2015-03-23 |