| NPI | 1467468447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.025708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18605) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-03-17 |