| NPI | 1467531657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 37835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 1651-850) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2013-03-19 |