| NPI | 1427290378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-57694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 10471A) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2017-07-13 |