| NPI | 1467683565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8713) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2013-03-25 |