| NPI | 1467525030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102202404) |
| 207Q00000X Family Medicine (Licence: IA 4336) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2015-01-23 |