| NPI | 1437358041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8114) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2015-08-05 |