| NPI | 1437379575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GU M001250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU M-1250) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2019-06-30 |